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This may induce post-traumatic hypothermia which increases mortality. The aim of this study was to assess the ability of warming systems to compensate for the victim\u2019s estimated heat loss in a simulated mountain rescue operation. We used thermal manikins and developed a thermodynamic model of a virtual patient. Manikins were placed on a mountain rescue stretcher and exposed to wind chill indices of 0 \u00b0C and \u2212 20 \u00b0C in a climatic chamber. We calculated the heat balance for two simulated clinical scenarios with both a shivering and non-shivering victim and measured the heat gain from gel, electrical, and chemical warming systems for 3.5 h. The heat balance in the simulated shivering patient was positive. In the non-shivering patient, we found a negative heat balance for both simulated weather conditions (\u2212 429.53 kJ at 0 \u00b0C and \u2212 1469.78 kJ at \u2212 20 \u00b0C). Each warming system delivered about 300 kJ. The efficacy of the gel and electrical systems was higher within the first hour than later (<jats:italic>p<\/jats:italic> &lt; 0.001). We conclude that none of the tested warming systems is able to compensate for heat loss in a simulated model of a non-shivering patient whose physiological heat production is impaired during a prolonged mountain evacuation. Additional thermal insulation seems to be required in these settings.<\/jats:p>","DOI":"10.1007\/s00484-020-02008-6","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T02:03:05Z","timestamp":1598925785000},"page":"2161-2169","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of warming systems in mountain rescue: an experimental manikin study"],"prefix":"10.1007","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-2659","authenticated-orcid":false,"given":"Pawe\u0142","family":"Podsiad\u0142o","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5684-8276","authenticated-orcid":false,"given":"Ewa","family":"Zender-\u015awiercz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-8633","authenticated-orcid":false,"given":"Giacomo","family":"Strapazzon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6680-4525","authenticated-orcid":false,"given":"Sylweriusz","family":"Kosi\u0144ski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4648-3549","authenticated-orcid":false,"given":"Marek","family":"Telejko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5889-3209","authenticated-orcid":false,"given":"Tomasz","family":"Darocha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2752-6929","authenticated-orcid":false,"given":"Hermann","family":"Brugger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,1]]},"reference":[{"key":"2008_CR1","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1034\/j.1399-6576.2002.460108.x","volume":"46","author":"A Brauer","year":"2002","unstructured":"Brauer A, English MJM, Sander H, Timmermann A, Braun U, Weyland W (2002) Construction and evaluation of a manikin for perioperative heat exchange. 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